Children A number of factors can alter a child's bowel habits, including unavailable toilet facilities; emotional distress; febrile illness: chronic medical conditions (e.g., cystic fibrosis and hypothyroidism); family conflict: dietary changes (e.g.. switching from human to cow's milk); or a change in daily routine or environment. Some children are poor or picky eaters, which may contribute to the development of constipation due to inadequate bulk and fluids in the diet. Constipation associated with an organic or pathologic etiology is uncommon in children." Bowel movement patterns vary widely in children; therefore constipation can be a complex problem that is often difficult to detect and manage. Selected Laxative Products Trade Name Primary Ingredients Bulk-Forming Laxatives Citrucel Powder Methylcellulose 2 g/tsp Citrucel Sugar Free Powder Methylcellulose 2 g/tsp FiberCon Tablets Calcium polycarbophil 625 mg Maltsupex Liquid Barley malt extract 750 mg/tsp Metamucil Fiber Wafer Psyllium hydrophilic mucilloid 3.4 g/2 wafers Metamucil Read more [...]

The ideal laxative would (1) be nonirritating and nontoxic, (2) act on only the descending and sigmoid colon, and (3) produce a normally formed stool within a few hours, after which its action would cease and normal bowel activity would resume. Because no currently available laxative precisely meets these criteria, proper selection of a laxative depends on the etiology of the constipation. Agents used to treat constipation have been classified according to their chemical structure and site, intensity, or mechanism of action. The most meaningful classification is by mechanism of action, including bulk-forming, emollient, lubricant, saline, hyperosmotic and stimulant agents. None of these laxative agents should be taken for more than 1 week without consulting a primary care provider. Bulk-Forming Agents Most bulk-forming laxatives are derived from natural sources such as agar. plantago (psyllium) seed, kelp (alginates) and plant gums (e.g.. tragacanth, chondrus, karaya [Sterculia]). Guar gum is a natural product found in the bean cluster plant (Cyamopsis tetragonolobus); it is most useful today Read more [...]

If you try all of the above without real success then medication's what you need. There is a tremendous, unjustified fear of laxatives, and I will address this shortly. There is a general understanding that stool withholding will take as long to treat as it has taken to develop. This is usually many months or even years. The three questions that you are going to ask about laxatives: 1.   Are they safe? 2.   Will they make his bowels lazy? 3.   Will he become dependent on them? As we will discuss, the answers to these questions, in order, are: Yes, No, No. The laxatives that we will discuss all have good safely profiles and appear to be safe in children. Other than some abdominal pain or diarrhoea, side-effects are extremely uncommon. The right dose is the one that works This is often more than GPs are used to prescribing or pharmacists are used to dispensing. Don't worry. Remember we are going for results here. If we gave a lower dose, and there were still lots of holding on, we might as well not be giving anything at all. I have said that it takes a long time to Read more [...]

Constipation is one of the most common digestive complaints in the general population. Over 2.5 million people consult a physician and hundreds of millions of dollars are spent on laxatives each year. Although constipation is often defined as a frequency of defecation twice weekly or less, constipated patients may complain of excessive straining with defecation, passage of hard or small stools, difficulty initiating evacuation, or a feeling of incomplete evacuation. Physicians should therefore not rely only on the criteria of defecation frequency when examining patients and managing constipation. TABLE. Laxatives Used in the Treatment of Constipation Laxatives Usual Adult Dose Onset of Action Bulk-forming laxatives Bran 2-4 tablespoons qd 12 to 72 h Methylcellulose 1 to 3 tbsp qd 12 to 72 h Psyllium 1 to 3 tbsp qd 12 to 72 h Calcium polycarbophi 2 to 4 tablets qid 24 to 48 h Osmotic agents Polyethylene glyco 17 g in 240 mL water 24 to 48 h Sorbito 15 to 30mLqd 24 to 48 h Lactulose 15 to 30mLqd 24 to 48 h Saline laxatives Magnesium Read more [...]

Bulk-Forming Laxatives Dietary fiber and bulk laxatives with adequate fluid intake are the most physiologic and safest of medical therapies. However, they may be counterproductive in patients with idiopathic slow transit constipation or with constipation associated with irritable bowel syndrome because they often worsen bloating and abdominal distension in these populations. Dietary Fiber Dietary fiber in cereals contain cell walls that resist digestion and retain water within their cellular structures, whereas those found in citrus fruits and legumes stimulate the growth of colonic flora and increase fecal mass. Wheat bran is the most effective fiber laxative with a clear dose response on fecal output. Patients with poor dietary habits may add 2 to 4 tablespoons of bran to each meal, followed by a glass of water or another beverage. A laxative effect may not be observed for 3 to 5 days. Patients should be cautioned that large amounts of bran can cause abdominal bloating or flatulence; therefore, they should start with small amounts and titrate slowly to the desired effect. Psyllium (Metamucil), Read more [...]

When available, we recommend directing the therapeutic intervention to the relevant underlying mechanism of chronic diarrhea by the use of appropriate testing. We prefer this approach to sequential empiric trials with antidiarrheals and other trials (eg, with dietary alteration and antibiotics). Celiac Sprue If the clinical examination or routine laboratory tests are suggestive of malabsorption, further testing should be undertaken to identify potentially relevant conditions, specifically celiac sprue, bacterial overgrowth, and pancreatic exocrine insufficiency. Anti-endomysial and antitissue transglutaminase antibodies should be sought, and, eventually, a jejunal biopsy will be needed to confirm any positive serological findings. In patients with concomitant diabetes and celiac disease confirmed by jejunal biopsy, the institution of a gluten-free diet leads to the regression of mucosal abnormalities and typically normalizes bowel habits. There is a separate chapter on celiac. Gut Dysmotility and Hypersecretion The presence of gut dysmotility can be assessed by means of radiographic, breath Read more [...]

Q: Our 3-year-old boy has had a problem with constipation. His doctor has checked him out and didn't find anything unusual. He recommends giving him one to two teaspoons of mineral oil in orange juice at bedtime to ease the constipation. My questions are: What's causing this problem? Are there any other options for treatment? If I give our son mineral oil repeatedly, do we run the risk of lazy bowels? Is there any basis to claims that mineral oil inhibits the body's ability to process vitamins? A: The first step is to make sure that all you're dealing with is simple constipation, which is a common problem in young children. Then you can decide what treatment to use. One of the most common causes of constipation is lack of adequate fiber or water in the diet. Another common cause is irregular bowel habits, sometimes stemming from painful bowel movements. For example, if your child becomes constipated for any reason and has a hard time moving his bowels, he may develop an anal fissure -- a small tear in the anal opening. This painful condition will make him not want to move his bowels, which Read more [...]

Diarrhea is a troublesome discomfort that affects most individuals in the United States at some point in their lives. Usually diarrheal episodes begin abruptly and subside within 1 or 2 days without treatment. This chapter focuses primarily on noninfectious diarrhea, with only minor reference to infectious diarrhea. Diarrhea is often a symptom of a systemic disease and not all possible causes of diarrhea are discussed in this chapter. To understand diarrhea, one must have a reasonable definition of the condition; unfortunately, the literature is extremely variable on this. Simply put, diarrhea is an increased frequency and decreased consistency of fecal discharge as compared to an individual's normal bowel pattern. Frequency and consistency are variable within and between individuals. For example, some individuals defecate as often as three times per day, whereas others defecate only two or three times per week. A Western diet usually produces a daily stool weighing between 100 and 300 g, depending on the amount of nonabsorbable materials (mainly carbohydrates) consumed. Patients with serious Read more [...]

Q. I occasionally have a problem with constipation, and fortunately it usually clears up by itself. But if I ever should need to take something for it, what should I take? I've noticed all kinds of laxatives, stool softeners and other treatments for constipation at the drug store, but I'm not sure what works best. Also, should I ever be concerned about what's causing the constipation? A.Many people have constipation from time to time, and it's usually not a sign of anything wrong. Every now and then, however, it can be a clue to an underlying problem with your intestines, even something as serious as cancer. So if your constipation is severe or persistent, check with your doctor to make sure nothing serious is going on. Oddly enough, there's no universally accepted definition of constipation. For some people, it means moving your bowels less often than usual; for some it means having painful or difficult bowel movements. And for others, it's both. Even excluding serious problems, there can be many reasons why you're constipated. These include being inactive, not drinking enough fluids Read more [...]

Monroe Community Hospital "Effects of Dietary Fiber - LiquaFiber™ - on Replacing Bowel Medications and Psyllium Fiber use in Long Term Care Residents" This clinical trial was performed at Monroe Community Hospital in Rochester, New York. Monroe Community Hospital is a 560-bed long-term care facility that has a unique patient mix. The facility has residents of all ages, from children as small as infants to the elderly. The facility boasts one of the finest Alzheimer's units in the country and has a high speed transitional care unit that offers wonders in a variety of therapies. This study began on March 1st and ran until April 20th . Problem Like most long- term care facilities MCH faces the everyday problems associated with constipation and bowel management. One of the contributing factors is the difficulty of patients obtaining the Recommended Daily Allowance of fiber. The products available require large amounts of liquid to be ingested which is very difficult for residence to consume on a consistent basis. The patients are afflicted with taste fatigue and refuse the treatment, hence Read more [...]